Syphilis: A major public health challenge?

Syphilis is a sexually transmitted bacterial infection that can threaten good health with fatal consequences if left untreated or improperly treated. Usually the infection starts as painless sores located around the genitals, rectum or mouth. Syphilis spreads among human only through broken skin or mucous membrane contact with the syphilis sores.

After the initial infection, the syphilis bacterium can be dormant in the body for decades before reappearing. This infection is a public health burden in developed and developing countries, affecting many races, gender and ages at various degrees of severity and frequency. Presently syphilis causes deaths in hundreds of thousands globally, largely due to increased rate of promiscuity, rape and prostitution.

This highly contagious infection is treatable in the early stages. Previous successful treatment does not protect someone from reinfection after a contact with syphilis infected sore or chancre. Without treatment, it can lead to permanent disability, neurological disorders, cardiac and congenital defects among other ill health problems; and preventable death finally. It is important to make yourself readily available to expert health care providers for tests and retests for syphilis, and early treatment with effective antibiotic, Penicillin.

What is syphilis?

Syphilis is a sexually transmitted infection (STI). The first presentation of syphilis is in form of small, painless sore on the genitals, rectum or inside the mouth. This sore is called a chancre which some people may not notice immediately. The four stages of syphilis which present varying signs and symptoms are primary, secondary, latent and tertiary.

Causes of Syphilis

The causative bacterium for syphilis is called Treponema pallidum, which most commonly enter the body through contact with an infected person’s sore during sexual activities. Syphilis is mostly contagious during its primary and secondary stages, and in the early latent period occasionally.

Transmission of syphilis

In rare circumstances, syphilis can be transmitted through direct unprotected contact with an active lesion or sore during intense kissing. The infection is mainly transmitted through direct contact with syphilitic sore(s) on the skin or mucous membranes of vagina, anus, rectum, lips or mouth during oral, anal or vaginal sexual intercourse. An infected mother can transfer syphilis to her unborn baby during pregnancy or newborn during childbirth (congenital syphilis).

People who tested positive for syphilis infection should notify all their recent sexual partners with persuasion to get tested and treated so as to break further transmission. It should be noted that syphilis bacterium die very fast outside of the body. Therefore, it can neither be transmitted through sharing of toilet, bathtub, clothing or eating utensils nor from doorknobs, swimming pools, screened donated blood or hot tubs.

Stages of syphilis infection

The four stages of syphilis are primary, secondary, latent and tertiary. The first two stages are most infectious. Latent stage is when the syphilis infection is hidden or dormant in the body of the affected person without signs and symptoms. Tertiary syphilis is the most destructive and deadly. The stages are described below.

Primary Stage

The primary stage of syphilis is highly infectious and starts about 3-4 weeks after exposure during sexual activity and remains in the affected part for 2-6 weeks. It manifests with painless sore(s) called chancre which may appear at the entry port of the causative bacterium. The sore usually appears on or inside the genitals, mouth or rectum. The sore(s) may heal without treatment after six weeks, leaving no scar. However, adequate treatment is needed here.

Secondary Stage

This stage is marked by mucus membrane ulcers or sores and non-itching skin rash on one or more areas of the body within 4-10 weeks of the chancre healing. The characteristic rash may be observed as faint, rough, red or reddish-brown spots mainly on the palms of the hands and the soles of the feet. The signs and symptoms of secondary syphilis can disappear with or without treatment. Notwithstanding, proper treatment is needed to break its progression to other subsequent stages of the infection.

Latent stage

The third stage of syphilis infection which starts about a year after secondary stage is when the bacterium is hidden inside the body of the affected person without clear signs and symptoms. This delicate stage could persist for 11 months to 2 years before tertiary stage sets in. Therefore earlier appropriate treatment is essential to avoid this stage of syphilis infection that recurs with severe damaging effects to body organs including the brain.

Tertiary stage

According to the Mayo Clinic, approximately 15-30 percent of people who were not treated/properly treated will enter this last stage of syphilis infection. This life-threatening, but non-infectious stage with many deadly signs and symptoms can manifest 2-15 years after the initial infection. This stage should be avoided.

Signs and symptoms of stages of syphilis

Syphilis is categorized into four stages which are associated with different signs and symptoms which can overlap. The contagious stages include primary, secondary and sometimes, the early latent phase. The tertiary stage of syphilis infection is known for most dangerous signs and symptoms but not contagious. However, in some cases, there may not be obvious signs and symptoms for several years.

Primary

The signs and symptoms of primary stage are:

One or many painless, firm and round sores called chancres at the infection site (mouth, vagina, rectum, anus or penis) and enlarged lymph nodes near the groin.

The sores can heal on their own after 3 to 6 weeks, with the syphilis hidden in the body of an infected person who can still spread the disease.

This stage in known to be easily treatable and curable.

Secondary

The signs and symptoms of secondary stage, which can disappear or worsen if untreated include:

Swollen lymph nodes.

Alopecia.

Weight loss.

A non-itchy rash that may be rough, red or reddish-brown in colour, covering the entire body parts beginning from the trunk.

Wart-like sores/ulcers on the mouth, anus and genitals.

Muscle aches, headaches, sore throat and fever.

Fatigue.

Usually the above signs and symptoms of secondary stage of syphilis infection can be observed about 2 to 10 weeks after the first sore appears.

Latent

During this stage, syphilis infection can be dormant (hidden) in the body of some people for years without obvious signs and symptoms but with high risk of recurrence. Treatment is still recommended here, because the infection may still affect the nerves, brain, bones, heart and other vital organs of the body.

Late or tertiary

After a normal period of latency, tertiary stage of syphilis infection can occur 10 to 30 years later. The common signs and symptoms at this stage include:

Dementia.

Soft tissue swellings (gummas) that can cause soft tissue and bone destruction anywhere in the body.

Muscle control problems.

Numbness.

Personality changes.

Vision problems that may lead to blindness.

Neurosyphilis which is an infection of the brain or spinal cord resulting to stroke or meningitis.

Damage to the organs -liver, bones, heart, blood vessels and joints, leading to death finally.

Complications of syphilis

Without treatment, syphilis can lead to complications in many organs of the body. Treatment prevents future damages but cannot repair or reverse damages that are already caused by syphilis. The complications include:

Small bumps or tumors: The bumps which are called gummas, can form as dead tissue and fiber on all parts of the body, bones, liver or any other internal organ during the late stage of syphilis. Gummas typically disappear with treatment.

Neurological problems: The nerve disorders caused by syphilis are called neurosyphilis; where the infection involves the central nervous system (CNS). The problems can result to major CNS complications like loss of coordination, blindness, sudden-lightning-like pains, numbness, bladder incontinence, sexual dysfunction in men (impotence) and mental disorder within 4 to 25 years after the initial infection.

Aortic aneurysms: Cardiovascular syphilis typically occurs 10–30 years after the initial infection. This complication most commonly results in aortic aneurysm formation. Also, heart valves can be damaged by syphilis infection.

HIV infection: Sexually active adults with genital ulcers or sores from syphilis infection are about five times more likely to contract Human Immunodeficiency Virus (HIV). Syphilis sores can bleed easily and promote easy entry of HIV into the bloodstream during unprotected sexual behaviours. The genital sores or ulcers caused by syphilis infection make it easier to transmit and acquire HIV infection due to contact with oral or rectal mucous membranes during sexual intercourse.

People most vulnerable to syphilis infection

Evidences show that these groups of people are most likely exposed to syphilis. They include:

Fetus during pregnancy or infant during delivery from infected mother.

People who engage in unprotected sex especially with numerous sexual partners.

Men who have sexual contact with men.

People who are sexually active and HIV positive.

Incidence of syphilisinfection

The precise origin of syphilis infection is not clear. There are some documented cases of syphilis infection which makes it a global threat to financial and human resources.

It affects more than 1.6 million pregnancies a year, resulting in complications. It is worth mentioning that in 2015, Cuba recorded the first breakthrough in the world, with respect to eradication of mother to child transmission of syphilis infection.

Syphilis infection was widespread in Europe and other nations during the 18th and 19th centuries and decreased later in the 1980s and 1990s due to the advent of the use of an effective antibiotic, Penicillin. However, since about the 20th century, syphilis infection have been increasing at fluctuating rates among different genders in the United States, Canada, Africa, the United Kingdom, Australia and Europe, primarily attributable to unsafe sexual practices such as rape, sexual promiscuity and prostitution. For instance, in the United States, rate of syphilis infection in 2007 was about six times more in men than in women.

According to the Centers for Disease Control and Prevention in United States, there was a recorded 88,000 cases of syphilis in 2016, mostly among men who have sex with men. In 1999, about 12 million cases were reported especially in the developing countries. There were above 6 million cases in 2012 in the developed countries. In 2015, it caused about 107,000 deaths as against 202,000 in 1990 globally. The above samples of recorded cases and deaths were mostly among intravenous drug abusers, homosexuals and people with HIV infection.

Effects of syphilis on pregnancy, fetus and neonates

Pregnant women can transfer syphilis to their unborn or new babies, resulting to congenital syphilis. Congenital syphilis highly exposes pregnant women, fetus and newborn to breach of expectations; and severe and life-threatening health challenges.

Pregnant women can face the challenges of early fetal death or miscarriage, stillbirth, preterm or premature births. Newborns can experience low birth weight/difficulty gaining weight, saddle nose (loss of Nose Bridge), fever and small blisters on the hands and feet that later turns to copper-coloured bumpy or flat rash spreading to the face. There may be watery nasal fluid and neonatal deaths or death within few days after birth. Older infants and young children can manifest infections and Hutchinson teeth or abnormal, peg-shaped teeth. Bone pain, sight and hearing loss, inflamed joints and lower leg bones problems are common. And rashes, scars and gray patches on the genitals, anus and mouth can be observed.

Other general health discomforts of congenital syphilis include anemia, deformities, seizures and inflamed liver or spleen. Undetected congenital syphilis can develop into late stage syphilis in babies. This can result to damages to their brain, bones, teeth, eyes, ears, blood, liver and skin.

Diagnosis and treatment of syphilis

The diagnosis of syphilis can be challenging because someone can have it without experiencing any signs and symptoms for years. Syphilis can be diagnosed with two different quick blood tests performed by expert health care professionals in a standard health facility.

The only recommended and proven treatment at all stages of syphilis infection is the use of the antibiotic, Penicillin, administered at the dose(s) and durations that are related to the period/stage of infection. There are no home remedies or over-the-counter drugs that will cure syphilis infection. So expert medical care, advice and monitoring at standard health facility are highly required, especially for pregnant women and those who may not tolerate Penicillin due to allergic reactions. The goals of the treatment are to kill the syphilis bacterium, prevent further damage; and ease pain and discomfort. Syphilis that stays untreated for a long time can cause major permanent damages to important organs of the body like the heart and brain.

For good treatment outcome, sexual contacts must be avoided during the period of treatment and care of all syphilis sores on the bodies of infected persons. Both sexually active partners should be conclusively treated at the same time. So carry your sexual partner along so as to avoid preventable health complications from syphilis. Sexual activities can be resumed only after expert medical confirmation that both partners are totally cured/ free from the infection.

Prevention of syphilis infection

There is no effective vaccine presently for syphilis prevention. Therefore we must be in contact with expert health care professionals for regular medical check on the genitals, especially when there are experiences of abnormal discharge, sore or rash. Some good preventive measures to decrease the risk of syphilis infection include:

Abstaining from sex or unprotected sexual intercourse even after a cure from previous syphilis attack.

Staying mutually faithful to a tested and uninfected husband or wife.

Avoiding excessive use of alcohol and drugs that could potentially motivate unsafe sexual activities.

As a result of the deadly effects syphilis has on fetus and neonates, health professionals do recommend that all pregnant women be screened for the infection.

Make sure that the full course of treatment is religiously completed even if signs and symptoms of syphilis have disappeared.

Avoid all sexual activities until you and your partner are medically certified safe.